Whooping Cough: An Epidemic in Washington State

Pertussis also seen in Oregon, Wisconsin, Maine, and California.

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THURSDAY, July 19, 2012 —Whooping cough outbreaks are hitting several states across the country, including areas in the Pacific Northwest, Wisconsin and Maine. The number of cases in these states has steadily increased in recent months and continues to rise.

In Washington, the State Department of Health declared an epidemic earlier this year, as numbers reached staggering levels. More than 2,500 people are reported to have whooping cough, compared to 179 cases reported during the same period in 2011.

“We’re in the middle of a whooping cough epidemic,” said Tim Church, director of communications for the Washington State Department of Health. “We have about 10 times the number of cases we would expect to see in a normal year.”

Rising numbers also have been reported in Oregon, Wisconsin, and Maine. These startling numbers come after California had its worse bout with whooping cough in decades in 2010.

Pertussis, the formal name for whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It is characterized by uncontrollable, violent coughing that causes patients to take deep breaths that produces a “whooping” sound.

The disease is most dangerous for babies, with half of infants younger than 1 year of age diagnosed with pertussis requiring hospitalization, according to the Centers for Disease Control and Prevention.

Prior to the 1940s when the pertussis vaccine became available, whooping cough was widespread in the United States. Though it has since fallen off the radar for many in the country, its recent comeback can be attributed to several factors, according to experts.

Tom Skinner, a spokesman for the CDC, said that although it may come to mind, the outbreaks are probably not the result of the increase in the number of parents choosing not to vaccinate their children from certain diseases. Some parents have chosen this route in recent years because of a highly discredited claim in a 1998 medical journal that the MMR (measles, mumps, rubella) vaccine is linked to autism.

“It’s not likely that vaccine refusal is having a large role in this,” he said. “Pertussis is a bacterium that’s cyclical in nature. We see these outbreaks from time to time as immunity wanes in our populations.”

Skinner said the best solution to stop the outbreak and prevent future instances from occurring is to make sure everyone is up to date on their vaccinations. This entails a series of shots in babies and children up to the age of 7 and a Tdap booster shot, which protects against pertussis, tetanus and diphtheria, for teenagers and adults. Since the adult pertussis vaccine only became available in 2005, many teenagers and adults are walking around unvaccinated.

However, even people who are vaccinated may be susceptible to the disease.

“The vaccination isn’t 100 percent effective,” Skinner said. “So there are some cases where a person may get whooping cough even though they have been vaccinated.”

Another reason for the rise in numbers could be that more cases are being recognized and diagnosed than in past years when the symptoms may not have been as easy to recognize.

“Lab tests are much better at finding the pertussis bacterium,” said Dr. Peter Cieslak, Medical Director of the Oregon Immunization Program. “This may be part of the reason we’ve seen higher case counts. The testing is just a lot better than it used to be.”

Numbers in Oregon are much lower than in Washington, though they are still on the rise. There have been 388 cases reported as of June 25, compared with 134 cases during the same time in 2011.

For its part, the Washington State Department of Health started a public outreach campaign, trying to get as many people vaccinated as possible.

“We’ve been actively reaching out to doctors, clinics and the public, getting information out there to get as many people vaccinated to help fight the issue,” Church said.

The CDC also sent three investigators to the state to help determine the cause of the outbreak and eliminate its spread.

Wisconsin is also being hit hard, though there has been a decline in the number of new cases in recent weeks. The state reported 1,524 confirmed cases of pertussis as of June 15, compared to 166 at the same time in 2011.

Dr. Marylyn Ranta, director of physician affairs at the Children’s Hospital in Wisconsin said that people in the affected communities are responding quickly.

“When people hear pertussis, we want them to be alarmed,” she said. “This is a horrible disease that can kill babies. It’s incredibly important that the community gets vaccinated, which is what we have been seeing here.”

The pertussis outbreak also has spread to Maine, where 158 confirmed and probable cases have been reported, compared to 54 cases around the same time in 2011.

For both patients and parents of those affected by whooping cough, the experience can be terrifying.

In December, Christen Graham of Cumberland County, Maine, noticed her daughter Rachel’s cough would not go away.

“The cough interrupted every waking moment, and because it was constant, that meant every moment was waking, as she couldn't sleep,” Graham said.

Graham recalled one instance where Rachel coughed so hard, her nose began to bleed violently. After a swab test, Rachel, who had been vaccinated for pertussis, was diagnosed with whooping cough and began treatment with antibiotics.

Dr. Stephen Sears, Maine CDC’s state epidemiologist, said that although the number of cases in the state has increased every week in recent months, they are beginning to level off.

“School is out now, so I think there may be a chance we’ll see a decrease after a while, but I’m not sure we’re out of the woods just yet,” he said. The disease could spread through the summer-camp population, as well.

“It’s always a challenge to predict, but right now there are still susceptible individuals out there and it will be an issue until we can fully get the message out to vaccinate,” he said.

However, even if the numbers do decline, experts say the U.S. hasn’t seen the last of whooping cough.

“The vaccine is not going to eradicate pertussis,” Cieslak said, “It isn’t good enough to wipe out the disease, and it’s going to be around indefinitely. So the message we want to get out is to do what you can to protect yourself and get vaccinated because we’re going to continue to be exposed to it in the future.”

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